Use Cases for Healthcare Automation: Revenue Cycle Management

9 May 2018

Use Cases for Healthcare Automation: Revenue Cycle Management

Healthcare operations are often strained by challenges with ever-growing numbers of patients worldwide in combination with non-digitized processes, outdated legacy systems, and convoluted legal regulations. Players with stakes in the healthcare industry, from private practices and hospitals to pharmacies, to diagnostic laboratories, to health insurers, are looking into Robotic Process Automation (RPA) to drive operational quality and efficiency faster than ever before.

What RPA can do for Healthcare

RPA is a low-risk, fast-win business proposition and its applications in the healthcare field are abundant, from patient registration and scheduling to claims processing, to audit management. RPA systems cam mimic actions that are typically performed by humans on the computer when they execute work: they log into virtually any web and enterprise application, move files and folders, copy and paste data, fill in forms, extract structured and semi-structured data from documents, and more.

100% time savings

100% accuracy

A leading US-based healthcare service provider was looking for a way to ensure that customer requests for the reporting and compliance process get processed on time. Each day, forty reports were manually extracted from the CRM application – which provided the information on open and closed cases needed by associates to carry out their responsibilities. The process was manual, error-prone, and time-consuming. Now a UiPath Robot automatically downloads those reports every day and also triggers an email notification to an employee once the process is completed successfully. Automation has improved accuracy rates to 100% and increased operational quality, and allowed for 100% time savings.

Beyond the typical back-office functions there are other, more elaborate use cases for RPA. One of the most interesting ones is in the revenue cycle management process.

Streamlining patient scheduling

With RPA, doctor’s appointments can be scheduled based on diagnosis, location, insurance carrier, and other criteria after receiving a patient’s electronic appointment request. A UiPath Robot can then scan the data, filter it into a consolidated report, and route the report to a specific referral management representative for the appointment to be made. It results in increased satisfaction for both the patient and call center personnel and helps healthcare providers ensure that they are seeing an optimum number of patients each day.

Increasing patient compliance with discharge instructions

Patients are often given medications or asked to follow post-discharge guidelines (e.g., what symptoms to look for) when discharged from the hospital, an external process that is difficult for healthcare providers to monitor. UiPath can be used to ensure the accuracy of discharge instructions as well as send reminders to patients about prescription pick-ups or upcoming doctor’s appointments. What’s more is that the automation platform can notify healthcare providers if a patient may need further intervention or requests additional information. Considering that communication problems are one of the most common malpractice triggers, this RPA application is especially essential for contributing to compliance, improving HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, and reducing readmissions.

Accelerating account settlements

By automating accounts payable and receivable processes, RPA can inform patients of what they owe, obtain patient payment, and settle accounts in hours or days. With RPA, payments can be monitored in a much quicker and more effective manner than when overseen by a human employee. Another boost to the financial performance of healthcare providers, this use of RPA ensures that payment delays, refusals, and errors that slow cash flow are reduced, and that write-offs are minimized.

Improving claims management

As an insurance claim is filed each time a patient visits the doctor, claims processing is particularly necessary for the healthcare sector. Such a process — if left unautomated — is highly manual, time-consuming, and error-prone. And outdated claims processes not only have a significant impact on cash flow but can also hold up patient care. By decreasing the number of days that claims remain unresolved, UiPath can help both health providers and health insurance companies control claims handling: by reducing error, by preventing the non-compliance associated with miscoded claims, and by ensuring faster settlement to avoid delays in patient care.

Optimizing the audit process

RPA improves data quality and federal compliance to satisfy, for example, Recovery Audit Contractor (RAC) and other Medicare audits. UiPath bots are also able to save their actions into an activity log so that healthcare providers or insurance companies are always prepared for an unexpected external audit. This log file provides the process information necessary for an audit, e.g., which processes were executed and how, when exceptions were generated, and how employees intervened to deal with issues.

We’re barely scratching the surface

RPA tools continue to see unprecedented growth across industries including finance, HR, health. The transition to the use of RPA in healthcare teams adds value to the business by unlocking more time for doctors to develop a relationship with patients and clients, argues Capgemini

Whether deployed by healthcare providers or health insurance companies, RPA enables the entire healthcare industry to better balance time and resources, shift the operational focus to core business activities, and drive a positive, higher quality patient experience. RPA does the job of human employees in a fraction of the time, eliminating the risk of errors. It can also work around the clock, and its workload can be scaled up or down as needed. Cost savings typically range between 40 and 60 percent depending on the type of work. UiPath has seen processing times reduced by up to 90 percent. And we’re still only scratching the surface of RPA’s potential.